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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia: A Prospective Cohort Study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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  • German Community-Acquired Pneumonia Competence Network (CAPNETZ)
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RATIONALE: Hyperglycemia is associated with mortality in patients with community-acquired pneumonia (CAP) and hyperglycemia may be a biomarker of severity. However, hyperglycemia has a major disadvantage since the association is diminished in patients with diabetes mellitus (DM). This hampers the use of hyperglycemia as a biomarker. Accounting for habitual glucose levels could overcome this disadvantage.

OBJECTIVES: We hypothesized that the glycemic gap (the difference between plasma-glucose and the estimated average glucose) may be associated with mortality irrespective of DM.

METHODS: Among 1933 adults with CAP included in a prospective multicenter cohort we investigated the association between the glycemic gap and 90-day mortality. Hemoglobin A1c was used to estimate the average glucose. The association was assessed with Cox proportional hazard models after adjustment for age, gender, CURB-65 and comorbidities. In the prespecified analysis the absolute and the relative glycemic gap were used as a continuous variable. In an post-hoc analysis the absolute and the relative glycemic gap were used as a categorical variable grouped according to quartiles.

RESULTS: In the post-hoc analysis patients with the lowest (negative) and highest (positive) absolute glycemic gap quartiles had increased risk of 90-day mortality (HR 2.6 (95% CI 1.02-6.65) and 2.5 (95% CI 1.01-6.06)), respectively. A similar association was found for the relative glycemic gap. The associations were independent of age, CURB-65 score, gender or number of comorbidities and not modified by DM.

CONCLUSION: Patients with the highest and lowest glycemic gap may have an increased risk of 90-day mortality and the association was not modified by DM. These associations were found in an exploratory post-hoc analysis and should be validated in other populations before further conclusions can be made.

OriginalsprogEngelsk
TidsskriftAnnals of the American Thoracic Society
ISSN2325-6621
DOI
StatusE-pub ahead of print - 22 aug. 2019

ID: 57846269